Compositions and methods for delivering drugs to a vessel wall

ABSTRACT

The invention relates to balloon coatings and their use in delivering drugs via a drug-eluting balloon. The delivery can be, e.g., to a vessel wall.

RELATED APPLICATIONS

This is a continuation application of U.S. Non-Provisional ApplicationSer. No. 16/797,189, filed on Feb. 21, 2020, which is a continuation ofPatent Cooperation Treaty Application No. PCT/CA2019/050694, filed onMay 22, 2019, which claims the benefit of 35 U.S.C. § 119 based on thepriority of U.S. Provisional Application No. 62/674,998, filed May 22,2018, each of which is incorporated herein by reference in its entirety.

BACKGROUND OF THE INVENTION

The invention features balloon coatings and their use in deliveringdrugs to a vessel wall. The development of coated balloon catheters fordelivery of paclitaxel presents a number of technical challenges,including the problem of the transit-associated loss of paclitaxel whichcan arise in the process of the delivery of paclitaxel to a target site.It is recognized in the art that the dominant design challenge for thesuccess of drug-coated balloon technology is the development of acoating system with properties robust enough to physically maintain theagent on the surface of the balloon during transit of the device throughthe vascular system but still allow its rapid, uniform, efficient, anddirected (i.e., with limited downstream distribution) transference tothe vessel wall during balloon inflation (Gray and Granada, Circulation,121:2672-2680 (2010)).

The transit-associated loss of paclitaxel can occur during the passageof a coated balloon catheter from the point of entry into a blood vesselto arrival at the site where, and time when, the balloon is expanded tocontact the vessel wall with the paclitaxel coating. Thetransit-associated loss of paclitaxel is undesirable for two reasons:(i) paclitaxel available at the target site is reduced by thetransit-associated loss of paclitaxel, and (ii) paclitaxel is acytotoxic agent making the systemic release into the blood streamundesirable.

Another technical challenge for the development of coated ballooncatheters for delivery of paclitaxel is the problem of potentialembolization by paclitaxel-containing particles released during theprocedure.

There is a need for improved drug coating techniques to address thechallenges of transit-associated loss and potential embolization bydrug-containing particles.

SUMMARY OF THE INVENTION

The methods and compositions of the invention feature formulations forcoating balloons, and their use in drug delivery.

The invention features a coating including: (i) from 3% to 35% (w/w) ofa compound of formula (I)

F_(T)—[B—(oligo)]_(n)—B-F_(T)  (I),

wherein B is a hard segment formed from hexamethylene diisocyanate,oligo is an oligomeric segment including polytetramethylene oxide, F_(T)is a polyfluoroorgano group, and n is an integer from 1 to 10; and (ii)from 70% to 97% (w/w) crystalline paclitaxel dihydrate. In particularembodiments, the coating includes (i) from 15% to 25% (w/w) of thecompound of formula (I) and (ii) from 75% to 85% (w/w) crystallinepaclitaxel dihydrate. In some embodiments, the polytetramethylene oxidehas a molecular weight of from about 800 Da to 3,000 Da (e.g., fromabout 800 Da to 2,500 Da, about 800 Da to 2,000 Da, about 800 Da to1,500 Da).

In some embodiments, the polyfluoroorgano group is a polyfluoroalkylhaving a molecular weight of between 100-1,500 Da. In other embodiments,the polyfluoroorgano group is a radical of the general formulaCF₃(CF₂)_(r)CH₂CH_(2—) or CF₃(CF₂)_(s)(CH₂CH₂O)_(x) 13 , wherein r is aninteger from 2-20, x is an integer from 1-10, and s is an integer from1-20. In still other embodiments, the polyfluoroorgano group is aradical of the general formula CH_(m)F_((3-m))(CF₂)_(r)CH₂CH₂— orCH_(m)F_((3-m))(CF₂)_(s)(CH₂CH₂O)_(x)—, wherein m is 0, 1, 2, or 3; x isan integer between 1-10; r is an integer between 2-20; and s is aninteger between 1-20. In certain embodiments, the polyfluoroorgano groupis selected from (CF₃)(CF₂)₅CH₂CH₂O—, (CF₃)(CF₂)₇CH₂CH₂O—,(CF₃)(CF₂)₅CH₂CH₂O—, CHF₂(CF₂)₃CH₂O—, and (CF₃)(CF₂)₂CH₂O —,1H,1H,2H,2H-perfluoro-1-decanol; 1H,1H,2H,2H-perfluoro-1-octanol;1H,1H,5H-perfluoro-1-pentanol; and 1H,1H, perfluoro-1-butanol, andmixtures thereof.

In one embodiment of the above coatings, the coating is a coating on atleast a portion of a balloon catheter. In some embodiments, the ballooncatheter includes an energy generating element (e.g., an element thatgenerates ultrasound, heat, electromagnetic, mechanical, or vibrationalenergy). In particular embodiments, the balloon catheter includeslithotripsy electrodes for deliverying ultrasonic energy to a vesselwall. In another embodiment, the balloon catheter includes a mechanicalenergy generating element (e.g., wherein the balloon catheter is capableof scoring and/or cutting).

In another embodiment of the above coatings, the coating includes apaclitaxel concentration of from 1.0 μg/mm² to 6.0 μg/mm² (e.g., 1.5±0.5μg/mm², 2.5±0.5 μg/mm², 3.0±0.5 μg/mm², 3.5±0.5 μg/mm², 4.0±0.5 μg/mm²,4.5±0.5 μg/mm², 5.0±0.5 μg/mm², or 5.5±0.5 μg/mm²).

The coating can have a thickness of from 0.01 to 250 microns (e.g., from0.01 to 5 microns, 0.1 to 5 microns, 1 to 5 microns, 1 to 25 microns, 2to 25 microns, 5 to 50 microns, 5 to 100 microns, 10 to 250 microns, 15to 50 microns, or 20 to 125 microns). In particular embodiments, thecoating can have a glass transition of from −80 to 90° C. (e.g., from−80 to 5° C., −60 to 5° C., −50 to 20° C., −40 to 30° C., −30 to 40° C.,−20 to 40° C., or 25 to 90° C.). In still other embodiments, the coatingcan have a tack of from 1.0 to 200 g (e.g., from 1.0 to 100 g, 1.0 to 50g, 2.0 to 200 g, 2.0 to 100 g, 2.0 to 50 g, 1.0 to 25 g, 2.0 to 25 g,3.0 to 75 g, 3.0 to 50 g, 3.0 to 25 g, or 1.0 to 20 g). The coating canhave a viscosity of from 0.04 to 130 cps (e.g., from 20 to 130 cps, 50to 130 cps, 75 to 130 cps, 0.04 to 30 cps, 0.04 to 70 cps, 0.5 to 130cps, 0.5 to 13 cps, 0.5 to 30 cps, 0.5 to 70 cps, 1 to 130 cps, 1 to 20cps, 1 to 50 cps, 5 to 25 cps, or 5 to 75 cps). In some embodiments, thecoating has a contact angle hysteresis of the surface of from 20-120°(e.g., from 20-60°, 30-70°, 40-80°, 60-90°, 70-100°, 80-110°, 90-120°,60-120°, or 35-90°.

The coatings of the invention can be formed by a method including thesteps of: (x) dissolving the compound of formula (I) and paclitaxel in amixture of an organic solvent and water to form a solution, (y)depositing the solution onto a surface, and (z) drying the surface toform the coating. The coating can be applied to the surface of the bysolid deposition, spray coating, drop and drag coating, printing, or dipcoating the surface with the solution. In particular embodiments, theorganic solvent includes tetrahydrofuran, ethanol, acetone, heptane,hexane, methanol, ethyl acetate, toluene, isopropanol, or mixturesthereof. The solution can include from 0% to 20% (w/w) water (e.g.,1.0±0.5%, 2.5±1.0%, 5.0±2.0%, 7.0±1.5%, 8.0±2.0%, 12±2%, or 15±5% (w/w)water).

In a related aspect, the invention features a balloon catheter, whereinat least a portion of the surface of the balloon catheter includes acoating of the invention. In some embodiments, the balloon catheterincludes an energy generating element (e.g., an element that generatesultrasound, heat, electromagnetic, mechanical, or vibrational energy).In a particular embodiment, the balloon catheter includes an ultrasoundgenerating element (e.g., a lithotripsy electrode). In anotherembodiment, the balloon catheter includes a mechanical energy generatingelement (e.g., wherein the balloon catheter is capable of scoring and/orcutting).

In another aspect, the invention features a method of deliveringpaclitaxel to a vessel surface of a mammal, the method includingcontacting the vessel surface with a coating of the invention.

The invention further features a method for inhibiting restenosis at afirst site of a diseased vessel wall in a mammal in need thereof, themethod including: (i) providing a balloon catheter, wherein at least aportion of the surface of the balloon catheter includes a coating of theinvention; (ii) inserting the balloon catheter into a vessel of themammal and delivering the balloon catheter to the first site of thevessel wall; and (iii) expanding the balloon to contact the coating tothe first site and delivering the paclitaxel to the vessel wall.

In one particular embodiment, the balloon when expanded in water for 1minute produces a cumulative count of fewer than 1,500 particles greaterthan 25 μm in diameter (e.g., fewer than 1,400 particles, 1,300particles, 1,200 particles, or 1,000 particles greater than 25 μm indiameter). In certain embodiments of the method, in a porcine model from75% to 95% (w/w) of the paclitaxel is retained on the balloon catheterprior to delivery to the vessel wall. In other embodiments of themethod, in a porcine model from 45% to 65% (w/w) of the paclitaxel isretained on the balloon catheter immediately after delivery to thevessel wall.

The method of inhibiting restenosis can further include: (iv) followingstep (iii) and prior to removing the balloon catheter from the vessel,contracting the size of the balloon; (v) moving the balloon to a secondsite of the diseased vessel wall; and (vi) expanding the balloon tocontact the coating to the second site and delivering the paclitaxel tothe vessel wall. The method can further include: (vii) following step(vi) and prior to removing the balloon catheter from the vessel,contracting the size of the balloon; (viii) moving the balloon to athird site of the diseased vessel wall; and (ix) expanding the balloonto contact the coating to the third site and delivering the paclitaxelto the vessel wall.

In a related aspect, the invention features a method for inhibitingrestenosis at a first site of a calcified vessel wall in a mammal inneed thereof, the method including: (i) providing a lithotripsy ballooncatheter including one or more lithotripsy electrodes, wherein at leasta portion of the surface of the lithotripsy balloon catheter includes acoating including crystalline paclitaxel dihydrate dispersed in alipophilic carrier at a concentration of from 1.0 to 6.0 μg/mm² (e.g.,1.5±0.5 μg/mm², 2.5±0.5 μg/mm², 3.0±0.5 μg/mm², 3.5±0.5 μg/mm², 4.0±0.5μg/mm², 4.5±0.5 μg/mm², 5.0±0.5 μg/mm², or 5.5±0.5 μg/mm² PTX); (ii)inserting the balloon catheter into a vessel of the mammal anddelivering the balloon catheter to the first site of the vessel wall;(iii) expanding the balloon to contact the coating to the first site anddelivering paclitaxel to the first site of the vessel wall andactivating the one or more lithotripsy electrodes to delivery ultrasonicenergy to the calcified vessel wall; (iv) contracting the size of theballoon; (v) following step (iv) and prior to removing the ballooncatheter from the vessel, moving the balloon to a second site of thecalcified vessel wall; and (vi) expanding the balloon to contact thecoating to the second site and delivering paclitaxel to the second siteof the vessel wall and activating the one or more lithotripsy electrodesto delivery ultrasonic energy to the calcified vessel wall, wherein thelipophilic carrier includes butyryltrihexyl citrate or acetyl tributylcitrate, or the coating is a coating of the invention including acompound of formula (I).

In particular embodiments of the method, the coating includes 50% to 95%(w/w) (e.g., 55±5%, 65±5%, 75±5%, or 85±5% (w/w)) crystalline paclitaxeldihydrate and 5% to 50% (w/w) (e.g., 10±5%, 20±5%, 30±5%, or 40±5%(w/w)) butyryltrihexyl citrate.

In some embodiments of the method, the coating includes 50% to 95% (w/w)(e.g., 55±5%, 65±5%, 75±5%, or 85±5% (w/w)) crystalline paclitaxeldihydrate and 5% to 50% (w/w) (e.g., 10±5%, 20±5%, 30±5%, or 40±5%(w/w)) acetyl tributyl citrate.

In any of the above methods, the vessel can be a coronary vessel, aniliac vessel, or a peripheral vessel. For example, the method can beperformed as part of a surgical procedure selected from percutaneoustranslumenal angioplasty, coronary angioplasty, neurovascularangioplasty, balloon angioplasty for AV fistula and AV graft, or balloonaortic valvuplasty. In some embodiments, the method is performed toinhibit restenosis at the site of an arteriovenous shunt.

The invention features a coating including: (i) from 3% to 35% (w/w) ofa compound of formula (I)

F_(T)—[B—(oligo)]_(n)—B—F_(T)  (I),

wherein B is a hard segment formed from hexamethylene diisocyanate,oligo is an oligomeric segment including polytetramethylene oxide, FT isa polyfluoroorgano group, and n is an integer from 1 to 10; and (ii)from 70% to 97% (w/w) amorphous or crystalline rapamycin macrolide. Inparticular embodiments, the coating includes (i) from 5% to 25% (e.g.,15% to 25%) (w/w) of the compound of formula (I) and (ii) from 75% to95% (e.g., 75% to 85%) (w/w) amorphous or crystalline rapamycinmacrolide. In some embodiments, the polytetramethylene oxide has amolecular weight of from about 800 Da to 3,000 Da (e.g., from about 800Da to 2,500 Da, about 800 Da to 2,000 Da, about 800 Da to 1,500 Da). Inone example, the amorphous or crystalline rapamycin macrolide issirolimus.

In some embodiments, the polyfluoroorgano group is a polyfluoroalkylhaving a molecular weight of between 100-1,500 Da. In other embodiments,the polyfluoroorgano group is a radical of the general formulaCF₃(CF₂)_(r)CH₂CH_(2—) or CF₃(CF₂)_(s)(CH₂CH₂O)_(x) 13 , wherein r is aninteger from 2-20, x is an integer from1-10, and s is an integer from1-20. In still other embodiments, the polyfluoroorgano group is aradical of the general formula CH_(m)F_((3-m))(CF₂)₂CH₂CH₂— orCH_(m)F_((3-m))(CF₂)_(s)(CH₂CH₂O)_(x)—, wherein m is 0, 1, 2, or 3; x isan integer between 1-10; r is an integer between 2-20; and s is aninteger between 1-20. In certain embodiments, the polyfluoroorgano groupis selected from (CF₃)(CF₂)₅CH₂CH₂O—, (CF₃)(CF₂)₇CH₂CH₂O—,(CF₃)(CF₂)₅CH₂CH₂O—, CHF₂(CF₂)₃CH₂O—, and (CF₃)(CF₂)₂CH₂O —,1H,1H,2H,2H-perfluoro-1-decanol; 1H,1H,2H,2H-perfluoro-1-octanol;1H,1H,5H-perfluoro-1-pentanol; and 1H,1H, perfluoro-1-butanol, andmixtures thereof.

In one embodiment of the above coatings, the coating is a coating on atleast a portion of a balloon catheter. In some embodiments, the ballooncatheter includes an energy generating element (e.g., an element thatgenerates ultrasound, heat, electromagnetic, mechanical, or vibrationalenergy). In particular embodiments, the balloon catheter includeslithotripsy electrodes for deliverying ultrasonic energy to a vesselwall. In another embodiment, the balloon catheter includes a mechanicalenergy generating element (e.g., wherein the balloon catheter is capableof scoring and/or cutting).

In another embodiment of the above coatings, the coating includes anamorphous or crystalline rapamycin macrolide concentration of from 1.0μg/mm² to 10.0 μg/mm² (e.g., 1.5±0.5 μg/mm², 2.5±0.5 μg/mm², 3.0±0.5μg/mm², 3.5±0.5 μg/mm², 4.0±0.5 μg/mm², 4.5±0.5 μg/mm², 5.0±0.5 μg/mm²,5.5 ±0.5 μg/mm², 6.0±0.5 μg/mm², 6.5±0.5 μg/mm², 7.0±0.5 μg/mm², 7.5±0.5μg/mm², 8.0±0.5 μg/mm², 8.5±0.5 μg/mm², 9.0±0.5 μg/mm², or 9.5±0.5μg/mm²). In some embodiments, the amorphous or crystalline rapamycinmacrolide concentration is from 1.0 μg/mm² to 6.0 μg/mm² (e.g., 1.5±0.5μg/mm², 2.5±0.5 μg/mm², 3.0±0.5 μg/mm², 3.5±0.5 μg/mm², 4.0±0.5 μg/mm²,4.5±0.5 μg/mm², 5.0±0.5 μg/mm², or 5.5±0.5 μg/mm²).

The coating can have a thickness of from 0.01 to 250 microns (e.g., from0.01 to 5 microns, 0.1 to 5 microns, 1 to 5 microns, 1 to 25 microns, 2to 25 microns, 5 to 50 microns, 5 to 100 microns, 10 to 250 microns, 15to 50 microns, or 20 to 125 microns). In particular embodiments, thecoating can have a glass transition of from −80 to 90° C. (e.g., from−80 to 5° C., −60 to 5° C., −50 to 20° C., −40 to 30° C., −30 to 40° C.,−20 to 40° C., or 25 to 90° C.). In still other embodiments, the coatingcan have a tack of from 1.0 to 200 g (e.g., from 1.0 to 100 g, 1.0 to 50g, 2.0 to 200 g, 2.0 to 100 g, 2.0 to 50 g, 1.0 to 25 g, 2.0 to 25 g,3.0 to 75 g, 3.0 to 50 g, 3.0 to 25 g, or 1.0 to 20 g). The coating canhave a viscosity of from 0.04 to 130 cps (e.g., from 20 to 130 cps, 50to 130 cps, 75 to 130 cps, 0.04 to 30 cps, 0.04 to 70 cps, 0.5 to 130cps, 0.5 to 13 cps, 0.5 to 30 cps, 0.5 to 70 cps, 1 to 130 cps, 1 to 20cps, 1 to 50 cps, 5 to 25 cps, or 5 to 75 cps). In some embodiments, thecoating has a contact angle hysteresis of the surface of from 20-120°(e.g., from 20-60°, 30-70°, 40-80°, 60-90°, 70-100°, 80-110°, 90-120°,60-120°, or)35-90°).

The coatings of the invention can be formed by a method including thesteps of: (x) dissolving the compound of formula (I) and rapamycinmacrolide in a mixture of an organic solvent and water to form asolution, (y) depositing the solution onto a surface, and (z) drying thesurface to form the coating. In another example, coatings of theinvention can be formed by a method comprising the steps of: (x)dissolving the compound of formula (I) in an organic solvent and addingto crystalline rapamycin macrolide to form a suspension, (y) depositingthe suspension onto a surface, and (z) drying the surface to form thecoating. In some embodiments, the drying process increases rapamycinmacrolide crystallinity prior to sterilization. In further examples,sterilization or exposure to humidity can increase rapamycin macrolidecrystalline. The coating can be applied to the surface of the by soliddeposition, spray coating, drop and drag coating, printing, or dipcoating the surface with the solution.

In particular embodiments, the organic solvent includes methyltert-butyl ether, tetrahydrofuran, ethanol, acetone, heptane, hexane,methanol, ethyl acetate, toluene, isopropanol, or mixtures thereof. Thesolution can include from 0% to 20% (w/w) water (e.g., 1.0±0.5%,2.5±1.0%, 5.0±2.0%, 7.0±1.5%, 8.0±2.0%, 12±2%, or 15±5% (w/w) water).

In a related aspect, the invention features a balloon catheter, whereinat least a portion of the surface of the balloon catheter includes acoating of the invention. In some embodiments, the balloon catheterincludes an energy generating element (e.g., an element that generatesultrasound, heat, electromagnetic, mechanical, or vibrational energy).In a particular embodiment, the balloon catheter includes an ultrasoundgenerating element (e.g., a lithotripsy electrode). In anotherembodiment, the balloon catheter includes a mechanical energy generatingelement (e.g., wherein the balloon catheter is capable of scoring and/orcutting).

In another aspect, the invention features a method of deliveringrapamycin macrolide to a vessel surface of a mammal, the methodincluding contacting the vessel surface with a coating of the invention.

The invention further features a method for inhibiting restenosis at afirst site of a diseased vessel wall in a mammal in need thereof, themethod including: (i) providing a balloon catheter, wherein at least aportion of the surface of the balloon catheter includes a coating of theinvention; (ii) inserting the balloon catheter into a vessel of themammal and delivering the balloon catheter to the first site of thevessel wall; and (iii) expanding the balloon to contact the coating tothe first site and delivering the rapamycin macrolide to the vesselwall.

In one particular embodiment, the balloon when expanded in water for 1minute produces a cumulative count of fewer than 1,500 particles greaterthan 25 μm in diameter (e.g., fewer than 1,400 particles, 1,300particles, 1,200 particles, or 1,000 particles greater than 25 μm indiameter). In certain embodiments of the method, in a porcine model from75% to 95% (w/w) of the rapamycin macrolide is retained on the ballooncatheter prior to delivery to the vessel wall. In other embodiments ofthe method, in a porcine model from 10% to 65% (w/w) (e.g., 45% to 65%(w/w)) of the rapamycin macrolide is retained on the balloon catheterimmediately after delivery to the vessel wall.

The method of inhibiting restenosis can further include: (iv) followingstep (iii) and prior to removing the balloon catheter from the vessel,contracting the size of the balloon; (v) moving the balloon to a secondsite of the diseased vessel wall; and (vi) expanding the balloon tocontact the coating to the second site and delivering the rapamycinmacrolide to the vessel wall. The method can further include: (vii)following step (vi) and prior to removing the balloon catheter from thevessel, contracting the size of the balloon; (viii) moving the balloonto a third site of the diseased vessel wall; and (ix) expanding theballoon to contact the coating to the third site and delivering therapamycin macrolide to the vessel wall.

In a related aspect, the invention features a method for inhibitingrestenosis at a first site of a calcified vessel wall in a mammal inneed thereof, the method including: (i) providing a lithotripsy ballooncatheter including one or more lithotripsy electrodes, wherein at leasta portion of the surface of the lithotripsy balloon catheter includes acoating including crystalline rapamycin macrolide dispersed in alipophilic carrier at a concentration of from 1.0 μg/mm² to 10.0 μg/mm²(e.g., 1.5±0.5 μg/mm², 2.5±0.5 μg/mm², 3.0±0.5 μg/mm², 3.5±0.5 μg/mm²,4.0±0.5 μg/mm², 4.5±0.5 μg/mm², 5.0±0.5 μg/mm², 5.5 ±0.5 μg/mm², 6.0±0.5μg/mm², 6.5±0.5 μg/mm², 7.0±0.5 μg/mm², 7.5±0.5 μg/mm², 8.0±0.5 μg/mm²,8.5±0.5 μg/mm², 9.0±0.5 μg/mm², or 9.5±0.5 μg/mm²); (ii) inserting theballoon catheter into a vessel of the mammal and delivering the ballooncatheter to the first site of the vessel wall; (iii) expanding theballoon to contact the coating to the first site and deliveringrapamycin macrolide to the first site of the vessel wall and activatingthe one or more lithotripsy electrodes to delivery ultrasonic energy tothe calcified vessel wall; (iv) contracting the size of the balloon; (v)following step (iv) and prior to removing the balloon catheter from thevessel, moving the balloon to a second site of the calcified vesselwall; and (vi) expanding the balloon to contact the coating to thesecond site and delivering rapamycin macrolide to the second site of thevessel wall and activating the one or more lithotripsy electrodes todelivery ultrasonic energy to the calcified vessel wall, wherein thelipophilic carrier includes butyryltrihexyl citrate or acetyl tributylcitrate, or the coating is a coating of the invention including acompound of formula (I). In some embodiments, the crystalline rapamycinmacrolide is dispersed in the liphophilic carrier at a concentration offrom 1.0 μg/mm² to 6.0 μg/mm² (e.g., 1.5±0.5 μg/mm², 2.5±0.5 μg/mm²,3.0±0.5 μg/mm², 3.5±0.5 μg/mm², 4.0±0.5 μg/mm², 4.5±0.5 μg/mm², 5.0±0.5μg/mm², or 5.5±0.5 μg/mm²).

In particular embodiments of the method, the coating includes 50% to 95%(w/w) (e.g., 55±5%, 65±5%, 75±5%, or 85±5% (w/w)) crystalline rapamycinmacrolide and 5% to 50% (w/w) (e.g., 10±5%, 20±5%, 30±5%, or 40±5%(w/w)) butyryltrihexyl citrate.

In some embodiments of the method, the coating includes 50% to 95% (w/w)(e.g., 55±5%, 65±5%, 75±5%, or 85±5% (w/w)) crystalline rapamycinmacrolide and 5% to 50% (w/w) (e.g., 10±5%, 20 ±5%, 30±5%, or 40±5%(w/w)) acetyl tributyl citrate.

In any of the above methods, the vessel can be a coronary vessel, aniliac vessel, or a peripheral vessel. For example, the method can beperformed as part of a surgical procedure selected from percutaneoustranslumenal angioplasty, coronary angioplasty, neurovascularangioplasty, balloon angioplasty for AV fistula and AV graft, or balloonaortic valvuplasty. In some embodiments, the method is performed toinhibit restenosis at the site of an arteriovenous shunt.

In any of the above methods, the rapamycin macrolide can be selectedfrom sirolimus, zotarolimus, everolimus, temsirolimus, ridaforolimus,umirolimus, and biolimus.

The tack of a coating of the invention can be measured, for example,using a TA.XTPlus Texture Analyser (Stable Micro Systems; distributed byTexture Technologies Corp; Scarsdale, N.Y.), which measures tack in“grams of force”.

As used herein, “inhibiting restenosis” refers to reducing there-narrowing of artries following treatment to clear the blockage, suchas angioplasty, using a therapy of the invention in comparison to there-narrowing that would occur following treatment to clear the blockagein the absence of any further therapy to address the risk of restenosis.

As used herein, the term “cumulative count” refers to the numbers ofparticles produced by a balloon coated with 3.0 μg/mm² PTX using themethod described in Example 14.

As used herein, the term “rapamycin macrolide” refers to rapamycin (alsoreferred to as sirolimus) as well as other macrolide structuralanalogues of rapamycin which are inhibitors of the mTOR cellularsignaling pathway, and preferably inhibitors of mTOR itself. Rapamycinmacrolides include everolimus (Affinitor; RAD001), temsirolimus(CCI-779), ridaforolimus (previously known as deforolimus; AP23573),umirolimus (Biolimus A9), zotarolimus (ABT-578), novolimus, myolimus,AP23841, KU-0063794, INK-128, EX2044, EX3855, EX7518, AZD08055 andOSI027.

Other features and advantages of the invention will be apparent from thefollowing Detailed Description, the Drawings, and the Claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an optical image of Formulation 1 (ca. 80% (w/w) crystals ofPTX dihidrate dispersed in ca. 20% (w/w) compound 1) coated on nyloncoupon formed from different solvent compositions (E=ethanol, A=acetone,and H=water). Formulation 1 was prepared as described in Example 7.

FIG. 2 is an optical image of Formulation 2 (ca. 95% (w/w) crystals ofPTX dihidrate dispersed in ca. 5% (w/w) compound 1) coated on nyloncoupon formed from different solvent compositions (E=ethanol, A=acetone,and H=water). Formulation 2 was prepared as described in Example 8.

FIG. 3 is an SEM image of Formulation 1 coated onto balloon as describedin Example 11. The image depicts crystals of PTX dihidrate in thecoating.

FIG. 4 is an SEM image of Formulation 2 coated onto balloon as describedin Example 12. The image depicts crystals of PTX dihidrate in thecoating.

FIGS. 5A-5D are SEM and optical images of Formulation 1 on nylon andPebax balloons prepared as described in Example 13.

FIG. 6 is a graph depicting the cumulative number of particles formedfrom balloons bearing different PTX coatings following exposure to waterin a beaker as described in Example 14. The following coatings weretested: (a) Formulation 1 coated onto a Nylon 12 balloon catheter; (b)Formulation 1 coated onto a Pebax balloon catheter; (c) IN.PACT™Admiral™ drug coated balloon catheter; and (d) Lutonix® 035 drug coatedballoon PTA catheter. The coatings made from Formulaion 1 exhibit adramatic reduction in particle counts compared to the IN.PACT™ Admiral™and Lutonix® 035 balloons.

FIG. 7 is a graph depicting the post treatment PTX retention fordifferent balloon coatings in a flow loop model as described in Example16.

FIG. 8 is a graph depicting the post single treatment with shockwave PTXretention for different balloon coatings in a flow loop model asdescribed in Example 17.

FIG. 9 is a graph depicting the pre-deployment PTX loss in transit fordifferent balloon coatings in a porcine model as described in Example18.

FIG. 10 is a graph depicting the post-deployment (post-inflation) PTXloss for different balloon coatings in a porcine model as described inExample 19.

FIG. 11 is a graph depicting the PTX retention for Formulation 1 postmultiple inflation and lithotripsy treatments in a porcine model asdescribed in Example 20.

FIG. 12 is a graph depicting the segmentation of balloon treated vesselduring necropsy as described in Example 21.

FIG. 13 is a graph depicting the median level of paclitaxel (PTX) invessels following treatment with different coatings as described inExample 23. The median level of paclitaxel (PTX) in vessels treated withFormulation 1 (7.2 μg PTX/g of vessel) were double that of Pantera Lux(3.15 μg PTX/g of vessel), while the median level of PTX observed forFormulation 3 (0.04 μg PTX/g of vessel) and Formulation 4 (<0.01 μgPTX/g of vessel) delivered the lowest median levels of PTX to vessels.

FIG. 14 is a graph depicting the amount of paclitaxel (PTX) delivered tothe heart of in a porcine study as described in Example 23. It wasobserved that PTX was delivered at a consistently high dose toFormulation 1-treated hearts in comparison to other formulations. Eachbar of the graph represents a given heart; there were three total heartsper group.

FIG. 15 are a series of SEM images of Formulation 9 coated PTCA and PTAballoon catheters.

FIG. 16 are a series of SEM images of Formulation 9 coated PTCA ballooncatheters subject to various drying processes immediately after coating.

FIG. 17 is a graph depicting sirolimus release in PBS tween buffer ofFormulation 9 from Nylon 12 coupons after 24 hours.

FIG. 18 is a graph depicting drug retention for Formulation 9 coated PTAballoon catheters compared to Formulation 1 coated Nylon 12 PTA ballooncatheter, Formulation 1 coated Pebax PTA lithotripsy catheter, andcompetitor benchmarks Lutonix®, IN.PACT™, Ranger™, and Stellarex™.

FIG. 19 is a graph depicting drug retention for Formulation 9 coated onNylon 12 PTCA balloon catheter compared to Magic Touch drug-elutingballoon and Formulation 1 coated Nylon 12 PTCA balloon.

DETAILED DESCRIPTION

The methods and compositions of the invention feature coatings includinga compound of formula (I):

F_(T)—[B—-(oligo)]_(n)—B—B—F_(T)  (I),

wherein B is a hard segment formed from hexamethylene diisocyanate,oligo is an oligomeric segment including polytetramethylene oxide, FT isa polyfluoroorgano group, and n is an integer from 1 to 10; and (ii)crystalline paclitaxel dihydrate or a rapamycin macrolide.

Because the coatings of the invention do not have the properties of abase polymer, they are not susceptible to flaking or cracking during thephysical manipulation of the device, such as the expansion anddeployment of a balloon catheter. The coatings of the invention cancontrol the release of paclitaxel or rapamycin macrolide incorporatedwithin the coating by limiting the rate of diffusion of the agent fromthe coating prior to disruption of the coating (e.g., by deformation ofthe coating, or by exposing the coating to an energy source). A primaryfunction of such coating can be to increase efficacy of local deliveryof paclitaxel or a rapamycin macrolide for a defined period of time.

The coatings of the invention can be applied to the surface of a ballooncatheter in any number of ways including, but not limited, toelectrodeposition, dipping, drag coating, spraying, brushing, printing,or spin coating of the coating material from a solution or suspensionfollowed by solvent removal step as needed. Further description of howthe coatings can be made and applied is found in the Examples.

Vascular stenotic/occlusive diseases are mainly caused by changes inpathophysiobiology of the vasculature, resulting in thickening of thevessel lining from fatty deposits or plaques. The most popular mode oftherapy for vascular occlusive diseases is the surgical bypass. However,endovascular interventions have been recognized and practiced as analternative and viable mode of therapy. Balloon angioplasty is designedto expand occluded blood vessels based on balloon inflation, andcompression of plaque, allowing perfusion of the diseased tissue. Inmost endovascular interventions a guiding catheter is advanced in thepatient's vasculature until the distal tip of the guiding catheter islocated close to the targeted location. A guidewire is advanced out ofthe distal end of the guiding catheter into the patient's blood vessel,until the distal end of the guidewire crosses a lesion to be dilated. Adilation catheter having an inflatable balloon on the distal portionthereof is advanced into the patient's blood vessel over previouslyintroduced guidewire until the balloon of the dilatation catheter isproperly positioned across the lesion. The success of the endovascularintervention is generally high, but the vessel patency is often reduceddue to restenosis in the vicinity of the original lesion causingre-occlusion of the vessel. The ability to locally deliverpharmaceuticals from a balloon surface provides an approach incontrolling restenosis. The entire or partial external balloon surfacecan be coated with a desired pharmaceutical, the time of ballooninflation or the multiplicity of inflation can also be controlled,making the “drug eluting balloon” an adaptable and robust tool for localdrug delivery.

The compositions and methods of this invention can be used in variousapplications of drug eluting balloon technology, such as percutaneoustranslumenal angioplasty (PTA), coronary angioplasty (PTCA),neurovascular angioplasty (PTNA), balloon aortic valvuplasty (BAV).Furthermore, the composition of the invention allows incorporation ofvarious biological agents depending on the application of the drugeluting balloons.

In one application, DEB can also be used as balloon aortic valvuplastyto repair stenotic aortic valve which has become stiff from calciumbuildup. The balloon is inserted and inflated into the aortic valve toincrease the opening size of the valve and improving blood flow.Traditional balloon aortic valvuloplasty many times fails to preventrestenosis in patients. Drug eluting balloon in this case allows theincorporated antirestenotic drug to elute into dilated aortic valves toprevent restenosis post-treatment.

In another application, DEB can be used to treat coronary and peripheraldiseases which are not treatable by stenting. This is particularly truefor vessels below the knee in which the vessels are small and the stentstruts break under the torque. Additionally, DEB may be used to treatin-stent restenosis. In another example, DEB can be used to treatcoronary and peripheral diseases in combination with a stent.

One possible non-vascular application of drug eluting balloon islocalized chemotherapy. Balloon catheter can be coated with anticanceragent and introduced to cancerous tissue. A drug eluting balloon mayalso be used in the nasal cavity and can be used for treating, e.g.,chronic sinusitis, such as by coating the DEB with a rapamycinmacrolide.

Balloons for angioplasty are categorized as high pressure balloons. Astandard balloon consists of a cylindrical body, two conical tapers, andtwo necks. The particular angles and shapes of the balloon can becustomized depending on the application and particularities of thephysiology. High pressure balloons are also used to dilate constrictionsand blockages in other areas such as the esophagus, biliary-duct,urethra, fallopian-tube, heart-valve, tear-duct and carpel-tunneldilation. Other applications for high pressure balloons includepositioning, occlusion, light therapy, heat transfer and endovasculargraft delivery.

High pressure balloons are made from noncompliant or low-compliantmaterials (expand only 5-10%) which have controllable size and shape.Thin-walled, these balloons exhibit high tensile strength withrelatively low elongation. Currently most high pressure balloons aremade from PET or nylon. PET has high tensile strength with a maximumpressure rating. It can be molded to have ultra thin walls (5-50 mm)with diameters from 0.5-50 mm. Nylon is softer and can be easilyrefolded for easier withdrawal into the guiding catheter. Both materialshave demonstrated compatibility to coatings which provide lubricity,abrasion and puncture resistance, conductivity, thrombogenicity, drugrelease, and reflectivity, among other characteristics.

The rated pressure for angioplasty is 2-20 atm. Larger diameter balloonshave a lower rated pressure as the stress in the balloon wall increaseswhen inflated to the nominal diameter. PTCA balloon catheters areusually 2-4 mm in diameter, 10-40 mm in length and have a rate pressureof 10-20 atm. PTA balloon catheters are usually 4-14 mm in diameter and20-200 mm in length and have a rate pressure of 8-20 atm.

A wide variety of balloon catheters can be coated using the compositionsand methods of the invention to deliver paclitaxel or a rapamycinmacrolide at a desired site of treatment. The balloon catheters of theinvention can include energy sources including ultrasound, heat,electromagnetic, mechanical, and/or vibrational energy sources fordisrupting the coating and releasing the paclitaxel or a rapamycinmacrolide. For example, an ultrasound external energy source may be usedhaving a frequency in a range from 20 kHz to 100 MHz, preferably in arange from 0.1 MHz to 20 MHz, and an intensity level in a range from0.05 W/cm² to 10 W/cm², preferably in a range from 0.5 W/cm² to 5 W/cm².The ultrasound energy would be directed at the coating and eithercontinuously applied or pulsed, for a time period in a range from 5seconds to 10 minutes, preferably in a range from 1 minute to 3 minutes.Alternatively, the temperature of the surface of the balloon cathetercan be heated (e.g., in the range of from 36° C. to 48° C.), vibrated,or subjected to electromagnetic energy to facilitate the release ofpaclitaxel or a rapamycin macrolide at the desired place and time. Inanother example, the balloon catheter includes razor blades, struts, orpull wires that are capable of scoring and/or cutting.

The following examples are put forth so as to provide those of ordinaryskill in the art with a complete disclosure and description of how themethods and compounds claimed herein are performed, made, and evaluated,and are intended to be purely exemplary of the invention and are notintended to limit the scope of what the inventors regard as theirinvention.

EXAMPLE 1 Synthesis and Characterization of Compound 1

To dry reactor glassware was added 1 molar ratio of degassedpolytetramethylene oxide diol (M 1000) and dimethyl acetamide (DMAC). Tothe solution was added 2 molar ratio of hexamethylene diisocyanate, andthe reaction flask was placed in a water bath. 0.5 mL of dibutyltindilaurate (DBTDL) was added to the system. The reaction mixture wasstirred for 4 hours at 65° C. to produce the desired HDI PTMOprepolymer. Once the prepolymer reaction is complete, the reactorcontents were cooled to 45° C. and degassed FOH C8 was added to thereactor at a molar ratio of 2.3 to end-cap the prepolymer. A Syringe wasused to add ca 1.0 mL dibutyltin dilaurate (DBTDL). The reaction mixturewas stirred over night at 45° C. to produce the desired fluorinatedpolymers. The polymer was precipitated in deionized water under constantstirring. The Volume of water used for the precipitation should beapproximately 3.3 times the volume of the DMAc solvent in the solution.The polymer was purified by dissolution in boiling isopro panol,followed by cooling to 50-60° C., and precipitation by slow addition ofhexane. The precipitated polymer was collected on a filter and washedwith hexane. The purified poly mer was dried in a convection oven at 50°C. for at least 48 hours to produce compound 1 (general formula depictedbelow).

EXAMPLE 2 Synthesis and Characterization of Compound 2

MePEG (15.0 g, 20 mmol) was degassed and then dissolved in DMAc (243mL), and added dropwise into LDI-methyl (8.48 g, 40 mmol) in DMAc (49mL) in the presence of DBDL catalyst, at 40° C. over 3 hours under N₂.Perfluoroalcohol (24.024 g, 66 mmol) was degased and added to thereaction with present of DBDL catalyst, and stirred at room temperatureovernight under N₂. The product was purified by cationic SPE and solventextraction (Compound 2) (general formula depicted below). GPC (THFmobile phase): retention time of 26 minutes, Mw=1921g/mol, PDI=1.1.HPLC-ELSD analysis: MePEG:LDI-methyl:BAL content 76.9%,MePEG:LDI-methyl:MePEG content 23.1%. 1H NMR (400 MHz, CDCl3) δ (ppm)4.14-4.27 (—CH2—O, BAL), 4.27-4.45 (—CH2—O—CO, MePEG), 3.72-3.77 (CH3,LDI-methyl), 3.58-3.70 (CH2-CH2—O, MePEG), 3.07-3.22 (CH2—H,LDI-methyl), 2.35-2.55 (—CH2-CF2—, BAL), 1.22-1.90 (LDI-methyl CH2).Elemental analysis: 12.7% F, 46.7% C, 7.2% H, 2.1% N, <4 ppm Tin. DSCanalysis: Tg=−59° C. TGA analysis: Tdeg=275° C.

EXAMPLE 3 Sterilization of Compound 1 and Balloon Catheter

Compound 1 from Example 1 was weighed into polypropylene conical tubescapped with lint-free tissue, placed in sterilization pouches, and weresterilized by EtO. The sterilized compositions were analyzed by GPC, NMRand DSC. Results were compared to the pre-sterilization profile. Nochanges were observed for pre and post sterilization sample.

Balloon catheters coated with Compound 1+PTX (paclitaxel) dihydratecrystals were also sterilized by EtO. Sterilized and non-sterilizedballoon catheters were analyzed by HPLC, and PTX retention time pre andpost sterilization compared. PTX HPLC retention time (min):Pre-sterilization: 11.165 (PTX control: 11.163), post sterilization:10.84 (PTX control: 10.84). Visually, coatings were similar pre and poststerilization with no additional features noted.

EXAMPLE 4 Acute Systemic Toxicity

A single-dose systemic injection of Compound 1 in PBS (5.8 mg/kg) wasgiven to 5 Albino Swiss mice and toxicity observed over a 72 hourperiod. Mice were dosed at 50 mL/kg at an injection rate of ˜0.1 mL/sec.Observations for mortality and signs of pharmacological and/ortoxicological effects were made immediately post-injection and at 4, 24,48 and 72 hours post-injection. No clinical signs of toxicity wereobserved during the study period.

EXAMPLE 5 Cytotoxicity

Compound 1 was prepared using an extraction ratio of 6 cm²/1 mL 31.6 cm²of test article was extracted in 5.3 mL of Eagle's minimum essentialmedium (E-MEM)+5% fetal bovine serum (FBS). Samples were extracted at37±1 ° C. for 24±2 hours. The extract was inoculated onto the cell lineand incubated at 37±1° C. in a humidified atmosphere with 5±1% CO₂ inthe air. Positive and negative controls were run in parallel with thetest article. Cultures were evaluated for cytotoxic effects bymicroscopic observation after 24, 48 and 72 hour incubation periods. Thetest article passes and is considered non-cytotoxic under the testconditions employed.

EXAMPLE 6 Preparation of Compound 1+PTX and Characterization

Compound 1 and PTX (range from 50:50 to 5:95) were dissolved in varyingratios of acetone:ethanol (0:100 to 100:0) with varying water content(0-20%) and used immediately. The presence of PTX dihydrate drugpolymorph was confirmed by DSC analysis of material obtained afterevaporation of the solvents: T_(m)=146° C. (the Tm observed for PTXdihydrate alone).

EXAMPLE 7 Preparation of Formulation 1

Compound 1 and PTX were dissolved at 20:80 w/w ratio in acetone:ethanol(0:100 to 100:0 v/v ratio) solution with water and used immediately.Solutions were drop casted onto Nylon 12 coupons and visually inspected(see FIG. 1). The resulting coating, Formulation 1, contains ca. 80%(w/w) crystals of

PTX dihidrate dispersed in ca. 20% (w/w) compound 1.

EXAMPLE 8 Preparation of Formulation 2

Compound 1 and PTX were dissolved at 5:95 w/w ratio in acetone:ethanol(0:100 to 100:0 v/v) ratio) with water and used immediately. Solutionswere drop casted onto Nylon 12 coupons and visually inspected (see FIG.2). The resulting coating, Formulation 2, contains ca. 95% (w/w)crystals of PTX dihidrate dispersed in ca. 5% (w/w) compound 1.

EXAMPLE 9 Preparation of Formulation 3

Compound 1 and PTX were dissolved at 20:80 w/w ratio in tetrahydrofuranand used immediately. Solutions were drop casted onto Nylon 12 couponsand visually inspected. The resulting coating, Formulation 3, containsca. 80% (w/w) amorphous of PTX dispersed in ca. 20% (w/w) Compound 1.

EXAMPLE 10 Preparation of Formulation 4

Compound 2 and PTX were dissolved at 70:30 w/w ratio in tetrahydrofuranand used immediately. Solutions were drop casted onto Nylon 12 couponsand visually inspected. The resulting coating, Formulation 4, containsca. 30% (w/w) amorphous of PTX dissolved in ca. 70% (w/w) Compound 2.

EXAMPLE 11 Balloon Coating of Formulation 1 and Characterization

Compound 1 and PTX were dissolved in 1:1 acetone:ethanol with 5% (w/w)water and the resulting solution was immediately coated onto 5.0×40 mmNylon 12 percutaneous translumenal angioplasty (PTA) balloon cathetersby an drop and drag coater and dried overnight to form a coatingcontaining 3.0 μg/mm² PTX. SEM images of all coated balloons displayedcrystalline drug coatings (see FIG. 3).

EXAMPLE 12 Balloon coating of Formulation 2 and Characterization

Formulation 2 was dissolved in 1:1 acetone:ethanol with 5% (w/w) waterand the resulting solution was immediately coated onto 5.0×40 mm Nylon12 PTA balloon catheters by an in-house drop and drag coater and driedovernight to form a coating containing 3.0 μg/mm² PTX. SEM images of allcoated balloons displayed crystalline drug coatings (see FIG. 4).

EXAMPLE 13 Balloon Coating of Formulation 1 on Different BalloonPlatforms

Formulation 1 was coated on Nylon 12 and Pebax based PTA ballooncatheters using established drop and drag coating methods. Opticalmicroscopy and SEM showed similar coating morphology with crystallinedrug coatings on both Nylon 12 and Pebax balloons (see FIGS. 5A-5D).

EXAMPLE 14 Particle Size Analysis

A suitable apparatus was used based on the principle of lightblockagethat allows for an automatic determination of the size of particles andthe number of particles according to size. The apparatus is calibratedusing dispersions of spherical particles of known sizes between 10 mmand 25 mm. These standard particles were dispersed in particle-freewater. Care was taken to avoid aggregation of particles duringdispersion.

Particle Size Analysis for Formulation 1

Formulation 1 was coated on Nylon 12 and Pebax balloon catheters to forma coating containing 3 μg/mm² paclitaxel. Coated balloon catheters wereexposed to water in a beaker to nominal pressure and held for 1 minute.Water after inflation was analyzed by the particle counter APSS-2000,<788> as a general guideline. The cumulative number of particles weremeasured for (i) Formulation 1 on a 5×60 mm Nylon 12 balloon catheter(>10 μm: 5117, >25 μm: 664) and (ii) for Formulation 1 on a 5×60 mmPebax balloon catheter (>10 μm: 3146, >25 μm: 371).

Particle Size Analysis for Formulation 3

Formulation 3 was coated on 5×60 mm Nylon 12 balloon catheters to form acoating containing 3 μg/mm² paclitaxel. Coated balloon catheters wereexposed to water in a beaker to nominal pressure and held for 1 minute.Water after inflation was analyzed by the particle counter APSS-2000,<788> as a general guideline.

The cumulative number of particles were measured for Formulation 3 on aNylon 12 balloon catheter (>10 μm: 2204, >25 μm: 419).

Particle Size Analysis Conclusions

The particle counts observed for Formulation 1 coated on Nylon 12 andPebax balloon catheters was significantly lower than the particle countsof 6×60 mm IN.PACT™ Admiral™ drug coated balloon (>10 μm: 57213, >25 μm:12381), and 6×60 mm Lutonix® 035 drug coated balloon PTA catheter (>10μm: 55456, >25 μm: 25438) (see FIG. 6). The coatings made fromFormulation 1 exhibit a dramatic reduction in particle counts comparedto the IN.PACT® Admiral™ and Lutonix® 035 balloons. The presence ofcrystalline PTX in Formulation 1 did not significantly impact particlecounts relative to the non-crystalline

PTX coating of Formulation 3.

EXAMPLE 15 Assessment of Therapeutic Retention of Balloon Coating UnderFlow Conditions (Flow Loop Model)

Phosphate buffered saline at 37° C. was pumped by a peristaltic pumpthrough silicone tubing connections. The pump flow rate was set similarto the rate of blood flow through femoral arteries (350 mL/min). A Nylon12 PTA balloon catheter coated with Formulation 1 was placed in themiddle of the buffer flow for 2 minutes. The PTX remaining on theballoon catheter was measured by stripping the coating and quantifiedusing RP-HPLC with benzonitrile as the internal standard. The %PTXremaining was observed to be 95.7%.

Formulation 2 was tested under the same conditions and the %PTXremaining was observed to be 58%.

The high retention of PTX observed for Formulation 1 is consistent withvery little PTX lost prior to deployment of the balloon at the treatmentsite.

EXAMPLE 16 Assessment of Post Treatment Retention of Balloon CoatingUnder Flow Conditions (Flow Loop Model)

Phosphate buffered saline at 37° C. was pumped by a peristaltic pumpthrough silicone tubing connections. The pump flow rate was set similarto the rate of blood flow through femoral arteries (350 mL/min). A Nylon12 PTA balloon catheter coated with Formulation 1 was tracked throughthe silicone tubing under flow, then inflated to establish contact withthe silicone tubing. Once inflated, the balloon was held in place for 1minute, then deflated and removed from the tubing. PTX remaining on theballoon was measured by stripping the coating and quantified usingRP-HPLC with benzonitrile as the internal standard. The %PTX remainingwas observed to be 70.4%. The amount of PTX remaining on the ballooncoated with Formulation 1 was higher than that of the IN.PACT™ model (inhouse proxy, the %PTX remaining was observed to be 38%—see FIG. 7). Thehigh retention of PTX observed for Formulation 1 post balloon deploymentsuggest that deployment of the balloon at the treatment site does notcompromise the the ability of Formulation 1 to resist loss of PTX aftera treatment event.

EXAMPLE 17 Modulating Coating Retention on Balloon Surface AfterShockwave Treatment (Flow Loop Model)

Phosphate buffered saline at 37° C. was pumped by a peristaltic pumpthrough silicone tubing connections. The pump flow rate was set similarto the rate of blood flow through femoral arteries (350 mL/min). A Nylon12 PTA balloon catheter coated with Formulation 1 was tracked throughthe silicone tubing under flow, then inflated to establish contact withthe silicone tubing. Once inflated, the PTA balloon was held in placefor 1 minute, then deflated, tracked to a second location and inflatedto establish contact with the silicone tubing; the two locations werenon-overlapping. The balloon was held inflated in the second positionfor 1 minute, then deflated and removed from the tubing. PTX remainingon the Nylon 12 PTA balloon was measured by stripping the coating andquantified using RP-HPLC with benzonitrile as the internal standard. The%PTX retention was 59%.

In the same flow loop model, a Pebax PTA lithotripsy catheter coatedwith Formulation 1 was tracked through the silicone tubing under flow,then inflated to establish contact with the silicone tubing. Onceinflated, a mock lithotripsy treatment was initiated, consisting of anacoustic shock sequence with a 1 minute duration. At the end of theshock sequence, the PTA balloon was deflated, tracked to a secondlocation and inflated to establish contact with the silicone tubing, atwhich point a second 1 minute-long mock lithotripsy treatment wasperformed; the two locations were non-overlapping. At the end of thesecond shock sequence, the PTA balloon was deflated and removed from thetubing. PTX remaining on the Pebax PTA balloon was measured by strippingthe coating and quantified using RP-HPLC with benzonitrile as theinternal standard. The %PTX retention was 50%. The retention of theFormulation 1 on the balloon catheter is not impacted by the lithotripsytreatment (FIG. 8).

EXAMPLE 18 Assessment of Therapeutic Retention of Balloon Coating in aPorcine Model

Balloon catheters coated with Formulation 1 were tracked and placed atthe site of inflation in porcine femoral arteries (female farm pigs, Susscrofa domestica), without inflation, for 1 minute, and withdraw fromthe animal. Each animal was given ASA (0.081 g) and Clopidogrel (0.075g) by mouth daily for three days prior to treatment, and was fastedovernight before the procedure. For surgical procedures, after sedationa marginal ear vein was cannulated for infusion of intravenous fluidsand medications. The animal was intubated for administration ofanesthetic gases and placed on the catheterization table. Under sterileconditions, a vascular introducer sheath was placed in the right carotidartery by surgical cut down. Continuous hemodynamic andelectrocardiographic monitoring was maintained throughout the procedure.Using the guide catheter and or marker guidwire as a calibrationreference, the diameter of the vessel at reference sites proximal anddistal to the intended site of implant, as well as the target sitediameter, was measured. The remaining coating on the balloon catheterafter the procedure was extracted with appropriate solvent and PTXquanitified by RP-HPLC with benzonitrile as the internal standard. The%PTX released from wrapped balloons was 7% for the Nylon 12 platform,and 15% for the Pebax platform. These values are lower than those ofLutonix® and IN.PACT™ models, which were 48% and 38%, respectively (seeFIG. 9).

EXAMPLE 19 Assessment of Post Treatment Retention of Balloon Coating ina Porcine Model

Nylon 12, Pebax, and Pebax with shockwave balloon catheter coated withFormulation 1 were tracked and placed at the site of inflation inporcine femoral arteries (female farm pigs, Sus scrofa domestica), andinflated to a balloon-to-artery diameter ratio of ˜1.20. The nylon 12and Pebax balloon were inflated and held at the treatment location of 1minute for drug transfer, then withdrawn from the animal. The Pebax withshockwave balloon catheter were inflated, and a simulated lithotripsytreatment consisting of a 1 minute-long acoustic shock sequence wereperformed during the drug transfer period, then the balloon is withdrawnfrom the animal. Each animal was given ASA (0.081 g) and Clopidogrel(0.075 g) by mouth daily for three days prior to treatment, and wasfasted overnight before the procedure. For surgical procedures, aftersedation a marginal ear vein was cannulated for infusion of intravenousfluids and medications. The animal was intubated for administration ofanesthetic gases and placed on the catheterization table. Under sterileconditions, a vascular introducer sheath was placed in the right carotidartery by surgical cut down. Continuous hemodynamic andelectrocardiographic monitoring was maintained throughout the procedure.Using the guide catheter and or the marker guidewire as a calibrationreference, the diameter of the vessel at reference sites proximal anddistal to the intended site of implant, as well as the target sitediameter, was measured. The remaining coating on the balloon catheterafter the procedure was extracted with appropriate solvent and PTXquanitified by RP-HPLC with benzonitrile as the internal standard. The%PTX remaining on the balloons was 56% for the Nylon 12 balloon, and 58%for the Pebax balloon; the corresponding value for the Pebax balloonused in simulated lithotripsy was 53%. These values are higher thanthose of Lutonix® and IN.PACT™ models, which were 22% and 16%,respectively (see FIG. 10). Further, the Shockwave lithotripsy treatmentshowed a minimal impact on drug retention on the device in a porcinemodel.

EXAMPLE 20 Modulating Coating Retention on Balloon Surface AfterMultiple Shockwave Treatment in Porcine Model

Pebax with shockwave balloon catheter coated with Formulation 1 weretracked and placed at the site of inflation in porcine femoral arteries(female farm pigs, Sus scrofa domestica), and inflated to aballoon-to-artery diameter ratio of ˜1.20. The Pebax with shockwaveballoon catheter were inflated, and a simulated lithotripsy treatmentconsisting of a 1 minute-long acoustic shock sequence were performedduring the drug transfer period. At the end of the shock sequence, thePTA was deflated, tracked to a second location and inflated and a second1 minute-long mock lithotripsy treatment was performed. At the end ofthe second shock sequence, the PTA was deflated and removed from theanimal. Each animal was given ASA (0.081 g) and Clopidogrel (0.075 g) bymouth daily for three days prior to treatment, and was fasted overnightbefore the procedure. For surgical procedures, after sedation a marginalear vein was cannulated for infusion of intravenous fluids andmedications. The animal was intubated for administration of anestheticgases and placed on the catheterization table. Under sterile conditions,a vascular introducer sheath was placed in the right carotid artery bysurgical cut down. Continuous hemodynamic and electrocardiographicmonitoring was maintained throughout the procedure. Using the guidecatheter and or the marker guidewire as a calibration reference, thediameter of the vessel at reference sites proximal and distal to theintended site of implant, as well as the target site diameter, wasmeasured. The remaining coating on the balloon catheter after theprocedure was extracted with appropriate solvent and PTX quantified byRP-HPLC with benzonitrile as the internal standard. The %PTX remainingon the balloons was for 53% the Pebax balloon post first lithotripsytreatment, and 24% post 2^(nd) lithotripsy treatment (see FIG. 11). PTXretained on the balloon is available for further treatment.

EXAMPLE 21 PK Study in Porcine Model

60 mm long Nylon 12, Pebax, and Pebax with shockwave balloon catheterscoated with Formulation 1 were inflated in porcine peripheral arteriessimilar to example 17 at a balloon overstretch ratio of ˜20%. Animalswere sacrificed at specified time point (7d) and target vesselsharvested. The treated vessel (60 mm) was cut into 3 treated segmentsand analyzed separately. The proximal untreated tissue and the distaluntreated tissue are also harvested (FIG. 12). The concentration of PTXwere measured in the vessels using a liquid chromatography-tandem massspectrometry (LC-MS/MS) assay. The peak segmentPTX concentration isreported for each vessel (i.e. peak PTX concentration in segements 1-3)(μg PTX/g vessel): Nylon 12, 7d=0.1-172.8; Pebax, 7d=0.1-40.3; Pebaxwith shockwave 1^(St) treatment site, 7d =2.1-290.3; Pebax withshockwave 2nd treatment site, 7d=1.6-159.9.

EXAMPLE 22 Safety Study in Porcine Model

Coated Nylon 12 balloon catheter with Formulation 1 were inflated inporcine peripheral arteries similar to Example 21. Uncoated balloon(POBA) were used as controls and inflated in the similar fasion. Attermination seven days after balloon inflation, the animals wereeuthanized, the downstream skeletal muscles and main organs was excisedand examined for any abnormalities, and the vasculature was perfusedwith lactated Ringer's solution, then neutral buffered formalin andprocessed for histology. Artery segments were embedded in paraffin,sectioned (approximately 5 μm) and stained with hematoxylin and eosin(H&E) and Movat stain. Analysis by the study pathologist includedsemi-quantitative and descriptive histopathology and Histomorphometry.Higher fibrin and smooth muscle cell loss score of Formulation 1indicated drug effect in tissue, otherwise, no significant differencesin histology or Histomorphometry scores were noted between Formulation 1and POBA.

EXAMPLE 23 Preclinical Study in Porcine Model

A swine model was chosen for preclinical trials. Pigs were used becauseit had been extensively used for stent and angioplasty studies,resulting in a large volume of data on the vascular response propertiesand its correlation to human vascular response. These studies areconducted in vivo, as there are no suitable in vitro models that canmimic the complex biological responses to balloon angioplasty. Theporcine and human arteries have correlatively similar anatomy and theporcine model is recommended for use in preclinical studies by the FDAand Schwartz et al., Circulation. 106:1867-1873 (2002).

Sus scrofa pigs were used in these studies. The animals were at least 10weeks old, non-diseased, and all female or castrated. Each animal usedin the study was attributed a study number and tagged by an ear tag atangioplasty. For the blank animal, an ear tag was prepared but notinstalled. The protocol was reviewed and approved by the CIPAA forcompliance with the Canadian Council on Animal Care regulations prior tostudy initiation.

Procedures

To prevent or reduce occurrence of thrombotic events, animals wereadministered oral acetylsalicylic acid (325 mg) and clopidogrel (300 mginitial dose, 75 mg subsequently) at least three days prior tointervention and continuing until sacrifice. The drugs were crushed topowder and mixed with food; therefore, treatment was not administeredwhen animals were fasted.

Animals were fasted prior to anesthesia and were anesthetized withketamine, azaperone, and atropine or ketamine, acepromazine, andatropine administered intramuscularly (IM). Anesthesia induction ortracheal intubation was achieved with propofol injected intravenously(IV) via a catheter in a vessel of the left or right ear. Upon inductionof anesthesia, the subject animal was intubated and supported withmechanical ventilation. Isoflurane in oxygen was administered tomaintain a surgical plane of anesthesia.

In the K12 study described below, animals were injected IM with one doseof antiobitic Excede® (ceftiofur) to prevent postoperative infections.Torbugesic® (butorphanol) was administered IM to prevent painsensitization and minimize postoperative pain. Rimadyl® (carprofen, 3mg/kg, PO) was also administered as a postoperative analgesic on day 1.

In the K13 study described below, animals were injected IM with longaction penicillin (Duplocillin®, ProPen LA, Penpro or similar).Buprenophine HCl (Vetergesic) was administered IM was administered IM toprevent pain sensitization and minimize postoperative pain.

After induction of anesthesia, the left or right femoral artery wasaccessed through an incision made in the inguinal region. An arterialsheath was introduced and advanced into the artery. For localanesthesia, Bupivacain 0.25% was infiltrated and/or locally dropped intothe surgical site. An initial heparin bolus was administered andactivated clotting time (ACT) was measured at least every 30 minutes andrecorded. If ACT was <300 seconds, additional heparin was administered.

Blood samples of at least 3 mL in each tube were obtained from allanimals during the procedures (when the animal was under anesthesia)before treatment and prior to termination. For the blank, at least 200mL blood was collected and centrifuged to generate about 100 mL plasma.No blood samples was collected from the LIT animal. Samples werecentrifuged as per Testing Facility SOP within approximately 1 hour ofcollection. Plasma was harvested and was kept on dry ice pending storagein a −80° C. freezer pending shipment to the Analytical Chemistry Site.The blood sample harvested from the blank animal was performed afterappropriate sedation after propofol administration.

After treatment, animals were euthanized by inducing or maintaining deepanesthesia, followed by a lethal injection of saturated potassiumchloride (KCI, rapid IV bolus). Death was confirmed by observation ofventricular fibrillation on the ECG.

Vessel Angiography

An initial angiography was performed prior to treatment. Underfluoroscopic guidance, a guide catheter was inserted through the sheathand advanced to the appropriate location. After placement of the guidecatheter, nitroglycerin was delivered intraarterially to achievearterial vasodilatation and angiographic images of the vessel wereobtained with contrast media to identify the proper location fortreatment site (designated pre-treatment angiography). A segment ofartery was chosen, when possible, close to bifurcation or other markers,and measurements were performed up to the ostium to facilitate the sitelocation at harvest. A guidewire was inserted into the chosen artery.Quantitative Vessel Angiography (QVA) was performed at this time todocument the reference diameter for balloon angioplasty. Proximal anddistal reference diameter was noted.

A final angiography was also performed after treatment. After inductionof anesthesia, the artery of interest was accessed through an incisionmade in the inguinal region or a percutaneous access was used for someanimals. Nitroglycerin was delivered to the treated arteries to achievevasodilatation and QCA image capture was performed for each treated siteusing fluoroscopy. Each treated artery was qualitatively evaluated forlumen narrowing (treated and proximal/distal non-treated segments),dissection, thrombosis, and aneurysm.

The fluoroscopic output from the treated site (pre-treatment, balloonand post-treatment angiography) and at explantation (final angiography)were recorded in digital format. A single image was selected of thetreated area; from this image, QVA measurements were obtained usingMedis QCA-CMS 6.0 or QAngio® XA 7.3 (or higher) system. Parametersmeasured or calculated included:

-   -   Mean lumen diameter (or “lesion” on the Medis software reports)        of the treated region (balloon, post-treatment, and final        angiographies) or corresponding artery region (pre-treatment        angiography).    -   Minimal lumen diameter (MLD, or “obstruction” on the Medis        software reports) of the treated region (post-treatment and        final angiographies only).    -   Diameter stenosis [1—(MLD/RVD)]×100%] where RVD is a calculation        of the reference diameter at the position of the obstruction        (measure obtained by a software-based iterative linear        regression technique to generate an interpolation of a projected        vessel without the lesion) (final angiographies only).    -   Balloon to artery ratio [balloon/pre-implantation mean luminal        diameter].    -   Late loss [post-implantation MLD—final MLD]

Balloon Angioplasty

The balloon was introduced into the artery by advancing the ballooncatheter through the guide catheter and over the guide wire to thedelivery site. It was deployed to achieve balloon-to-artery ratio of1.20:1 (based on treated vessel segment) with a range of 1.15:1 to 1.3:1for at least 60 seconds to allow sufficient time for transfer of thetherapeutic balloon coating to the vessel wall, after which vacuum wasapplied to the inflation device in order to deflate the balloon.Complete balloon deflation was verified with fluoroscopy (designatedpost-balloon angiography). Blood perfusion was evaluated usingPeripheral Arterial Flow (PERI) grading or TIMI (Thrombolysis InMyocardial Infarction) flow grading; presence of major side branchesand/or tortuosity was noted. Balloon angioplasty was repeated in theother vessel sites until the target treatment number was reached. Aftertreatment, all balloons were kept in an appropriate vial (on dry ice orin a −80° C. freezer) for analysis. In cases when necessary, lidocainewas administered to treat cases of arrhythmia, nitroglycerin wasadministered to treat cases of arterial vasospasms, and atropine sulfatewas administered to treat bradycardia. No additional drugs wereadministered during the implantation procedures.

Necropsy

K12 Study—All treated animals surviving to scheduled termination weresubjected to a comprehensive necropsy, defined as gross examination ofthe heart and treated vessels, the whole body (external surface), allorifices, thoracic and abdominal cavities, and their contents. Lesionsfound during necropsy procedures/tissue collection were documented andcollected when feasible, immersion-fixed in neutral buffered formalin(NBF) and processed for histology. Untreated sites proximal and distalto the treated site, as well as the myocardium downstream to the treatedsite, were also harvested for analysis. All treated sites were used forpharmacokinetic analysis. Hearts were perfused with lactated Ringer'ssolution (LRS), then NBF and immersed in NBF with the animal's ear taguntil processed for histology. In addition to the animals that weretreated, the blank animal was used as a control for blood and tissueanalysis. LAD, LCx, and RCA vessels were harvested. Hearts were openedand then immersed in NBF with the animal's ear tag until possibleprocessing for histology. Portions of the distal myocardium from theblank animal were also harvested from the LAD, LCx, and RCA. A grossexamination of this animal was performed in order to assess any geneticabnormalities, such as cysts, that may have been present in the trialanimals.

K13 Study—In addition to the procedures described above, the skeletalmuscle on each leg was grossly examined. Samples were collected in thecenter of the muscle, immersion-fixed in neutral buffered formalin (NBF)pending possible histology. Coronary band (hoof) samples downstream fromthe external or internal femoral arteries were collected for each leg,and stored in NBF pending possible analysis. The blank animal was againused as a control for blood and tissue analysis. LAD, LCx, RCA, rightand left internal iliac arteries, and SFA/PFA vessels were harvested.The skeletal muscle and coronary band samples downstream from theexternal or internal femoral arteries were also collected.

Statistical Analyses

Selected values are expressed as mean±standard deviation. Statisticalevaluation of possible differences between groups in selected QCA andhistopathologic measurements was performed using Sigma Plot software.All Test and Control Articles were compared at 28D. A value of p <0.05was considered statistically significant.

For continuous data, equal variance and normality tests were initiallyperformed. When both were successful, One Way Analysis of Variance(ANOVA) was used (with Tukey's post-hoc tests for multiple comparisons).When either equal variance or normality tests failed, Kruskal-Wallis(ranks with Dunn's method) was conducted to compare groups.

For the histologic ordinal scores, the Kruskal-Wallis test (with Dunn'smethod for post-hoc group comparisons) was performed.

Preclinical Study K12

The objective of the study was to determine the amount of drug deliveredfrom the drug-coated balloons (DCBs) and retained after 28 days in thearterial wall and surrounding tissue of porince (Sus scrofa) coronaryarteries. A total of 22 animals were used; for histology: n=8; for PK:n=12; blank: n=1, and lost in transit (LIT): n=1.

There were five groups in this study. The three test articles werepaclitaxel-containing drug-coated balloon formulations with Formulation1, Formulation 3, and Formulation 4. As controls, uncoated balloons orBiotronik® Pantera Lux were used. 3.0 mm×20.0 mm balloons were used. Ineach pig, treatments were performed in the three main coronary arteries:left anterior descending coronary artery (LAD), left circumflex coronaryartery (LCx), and right coronary artery (RCA). One balloon type was usedper each pig.

All animals survived to 28 days with no notable clinical observations.Aneurysm, dissection, thrombosis, and lumen narrowing in the proximal ordistal marginal vessel were not observed at terminal angiography in allanimals. Lumen narrowing in the treated segment was observed in 15/60treated arteries, and blood flow in all arteries was rated as complete(flow grade of 3). As a result of the study, the RVD, overstretch, lateloss, and diameter stenosis are summarized below in Table 1.

TABLE 1 Results of study Uncoated Formulation 1 Formulation 3Formulation 4 Pantera Lux Parameter n = 4 n = 14 n = 14 n = 14 n = 14RVD (mm) 2.59 ± 0.19 2.50 ± 0.21 2.61 ± 0.35 2.56 ± 0.29 2.56 ± 0.31Overstretch 1.24 ± 0.03 1.23 ± 0.04 1.22 ± 0.04 1.21 ± 0.04 1.19 ± 0.03Late loss (mm) 0.05 ± 0.09 0.06 ± 0.13 0.11 ± 0.23 0.01 ± 0.03 0.06 ±0.15 Diameter stenosis (%) 15.13 ± 5.60  11.74 ± 7.64  11.35 ± 6.60 6.59 ± 5.55 14.32 ± 7.17 

It was observed that the median level of paclitaxel (PTX) in vesselstreated with Formulation 1 (7.2 μg PTX/g of vessel) were double that ofPantera Lux (3.15 μg PTX/g of vessel), while the median level of PTXobserved for Formulation 3 (0.04 μg PTX/g of vessel) and Formulation 4(<0.01 μg PTX/g of vessel) delivered the lowest median levels of PTX tovessels (see FIG. 13). For the two formulations that delivered thelargest amounts of PTX to the vessel, lower levels of PTX were observedin the distal myocardium with Formulation 1 (average=0.03±0.06) relativeto Pantera Lux (0.33±0.64). It was also observed that PTX was deliveredat a consistently high dose to Formulation 1-treated hearts, as shown inFIG. 14.

The consistency of Formulation 1 PTX delivery was observed across eachindividual animal, shown in Table 2, as well as across each vessel type,shown in Table 3.

TABLE 2 Delivery of PTX across each individual animal Average PTX (μgPTX/g of vessel) Formulation 1 Formulation 3 Formulation 4 Pantera LuxAnimal 1 (n = 3) 6.51 ± 6.05 0.00 ± 0.00 0.01 ± 0.01 1.70 ± 1.40 Animal2 (n = 3) 7.87 ± 6.58 2.10 ± 1.91 0.06 ± 0.10 10.94 ± 9.05  Animal 3 (n= 3) 8.23 ± 6.11 0.95 ± 1.31 0.01 ± 0.01 4.29 ± 6.42

TABLE 3 Delivery of PTX across each vessel type Average PTX (μg/vesseltype) Formulation 1 Formulation 3 Formulation 4 Pantera Lux RCA (n = 3)9.99 ± 3.63 1.63 ± 0.65 0.06 ± 0.03 3.08 ± 1.36 LAD (n = 3) 5.33 ± 2.241.27 ± 0.73 0.02 ± 0.01 2.73 ± 1.05 LCX (n = 3) 7.30 ± 2.95 0.15 ± 0.080.00 ± 0.00 11.12 ± 4.68 

Preclinical Study K13

A second study was performed to assess the safety of Formulation1-coated PTA balloons according to the procedures described above. Fourballoons (5.0×40.0 mm) were used in this experiment: Formulation1-coated percutaneous transluminal coronary angioplasty (PTCA), comparedto Biotronik® Pantera Lux, and Formulation 1-coated percutaneoustransluminal angioplasty (PTA) compared to Medtronic® IN.PACT™.

Treatments were performed either in the peripheral or coronary arteries.For PTCA, treatment was performed in the three main coronary arteries:left anterior descending coronary artery (LAD), left circumflex coronaryartery (LCx), and right coronary artery (RCA). For PTA, treatments wereperformed in the superficial femoral arteries (SFAs) and profundafemoris arteries (PFAs). One balloon type was used per each pig

Pharmacokinetic results for peripheral and coronary artery samples aresummarized below in Table 4. Overall, the coronary artery tissue PK datafrom confirms the high level of PTX delivery to the vessel wall fromFormulation 1-coated balloons, and the observed drop in tissue drugconcentration between 7 days (K13 study) and 28 d (K12 study) forFormulation 1-treated arteries is consistent with literature data forcommercial DCBs.

TABLE 4 PK results for peripheral and coronary arteries, by test group.PTX at 7 d PTX at 28 d from Test Group Description (μg/g) K12 study(μg/g) Coronary arteries Formulation Formulation 1 (80:20, 3.0 μg/m²PTX) on 104.1 ± 59.8 37.5 ± 26.7 1-HT PTCA QualiMed 3 × 20 mm,Hemoteq-coated n = 3 n = 9 Pantera Lux Biotronik ® Pantera Lux 3 × 20 mm 31.1 ± 23.0 24.5 ± 23.4 (BTHC excipient, 3.0 μg/m² PTX) n = 3 n = 8Peripheral arteries Formulation Formulation 1 (80:20, 3.0 μg/m² PTX) on1.02 (0.74, 1.30) N/A 1-HT PTA QualiMed 5 × 40 mm, Hemoteq-coated n = 2IN.PACT ™ Medtronic IN.PACT ™ Admiral ™ 5.45 (4.87, 6.02) N/A 5 × 40 mm(urea excipient, 3.5 μg/m² PTX) n = 2

While Formulation 1-treated peripheral arteries show lower PTX retentionthan those treated with the IN.PACT™ control, the drug tissue level forFormulation 1-treated arteries at 7 days is within the range ofclinically proven devices such as Lutonix (Bard) (1.0±0.9 μg/g 7 d aftertreatment with Lutonix balloons) (Yazdani et al., Catheterization andCardiovascular Interventions. 83:132-140 (2014)). This pilot study wasconducted with minimal coating optimization pre-work. As detailed inTable 4, analysis supports the potential for increased PTXuptake/retention for Formulation 1-coated balloons (near the level ofIn.Pact) by optimizing the coating morphology to provide full balloonsurface coverage.

Data from this study clearly support both high PTX transfer to coronaryartery walls as well as the viability of the Formulation 1 ballooncoating for peripheral artery applications. At 7 days after treatment,Formulation 1-treated coronary arteries show PTX tissue concentrationsof about 104 μg/g, a high value that is consistent with the 38 μg/gconcentration observed at 28 days in the previous study described instudy K12.

EXAMPLE 24 Preparation of Formulation 5

Compound 1 and sirolimus were dissolved at 20:80 w/w ratio inheptane:ethyl acetate (50:50 v/v ratio) and both solutions were usedimmediately. Solutions were drop casted onto Nylon 12 coupons andvisually inspected.

EXAMPLE 25 Preparation of Formulation 6

Compound 1 and sirolimus were dissolved at at 95:5 w/w ratio inheptane:ethyl acetate (50:50 v/v ratio) and both solutions were usedimmediately. Solutions were drop casted onto Nylon 12 coupons andvisually inspected.

EXAMPLE 26 Preparation of Formulation 7

Compound 1 and sirolimus were dissolved at 90:10 w/w ratio inheptane:tetrahydrofuran:methanol (72.5:22.5:5 v/v/v ratio) and usedimmediately. Solutions were applied onto Nylon 12 tubing using androp-and-drag coater and visually inspected. Examples at local drugdensity of 1.6 and 4 μg/mm² were prepared. The features observed withthe drop-casting and drop-and-drag coating methods were consistent. Acrystalline sirolimus drug polymorph was confirmed by DSC analysis ofmaterial obtained after evaporation of the solvents: T_(m)=180° C.

EXAMPLE 27 Preparation of Formulation 8

Compound 2 and sirolimus were dissolved at 20:80 w/w ratio inheptane:ethyl acetate (50:50 v/v ratio) and used immediately. Solutionswere drop casted onto Nylon 12 coupons and visually inspected. Ascompared to the Formulation 5 (Example 24), a lower crystal coverage wasobserved, as evidenced by the more prominent clear coating areas.

EXAMPLE 28 Exposure of Coating in Phosphate Buffered Saline Solution(PBS)

Formulation 5 and Formulation 8 coated Nylon 12 coupon were immersedinto phosphate buffered saline solution for 2 minutes. Formulation 5remained intact, while Formulation 8 exhibited significant particleshedding.

EXAMPLE 29 Preparation of Cryo-Milled Sirolimus and Characterization

1 to 1.5 g of sirolimus (crystalline, purchased from LC Laboratories®)was milled into micron-sized particles using a CryoMill (Retsch®) at−196° C., 30 Hz for 15 min. The crystalline sirolimus drug polymorph waspreserved and confirmed by X-ray powder diffraction (XRD) analysis andDSC. T_(m)=180° C.

EXAMPLE 30 Preparation of Formulation 9

Cyro-milled sirolimus from Example 29 was suspended in methyl tert-butylether (MTBE) with dissolved Compound 1 (range from 50:50 to 95:5 w/w)with varying sirolimus concentration (20-120 mg/mL) and used whilestirring. Suspensions were drop casted onto Nylon 12 coupons andvisually inspected. It was noted that the higher the sirolimusconcentration, the more crystalline the coating.

Closer inspection of Formulation 9 coatings under SEM indicates thatsirolimus concentrations greater than 80 mg/mL are substantiallycrystalline, as no clear evidence of amorphous morphological featureswas found during imaging. Formulation 9, therefore, yields coatings ofvarying degrees of sirolimus crystallinity depending on concentration.Specifically, solutions of a concentration ≥80 mg/mL can be used toprepare highly crystalline reference samples of Formulation 9(crystalline control). % crystallinity of the crystalline control asmeasured by PXRD: 92%.

EXAMPLE 31 Preparation of Formulation 10

Compound 1 and sirolimus were dissolved in tetrahydrofuran (THF) oracetone in proportions ranging from 50:50 to 95:5 w/w and a sirolimusconcentration range from 20-200 mg/mL. Solutions were drop casted ontoNylon 12 coupons and visually inspected. The resulting coatings werecolourless and transparent, consistent with amorphous sirolimus; resultswere equivalent with either THF or acetone solvents. The absence ofBragg peaks seen in the XRD analyses confirmed the amorphous nature ofthe material.

Formulation 10 in THF was coated onto 3.0×20mm Nylon 12 percutaneoustransluminal coronary angioplasty (PTCA) balloon catheters and 5.0x60mmNylon 12 percutaneous transluminal angioplasty (PTA) balloon cathetersby a drop-and-drag coating method and dried overnight to form coatingscontaining varying sirolimus loading (3.0-7.0 μg/mm²). The samecolourless and transparent coating characteristics noted for Nylon 12coupons were also observed on coated balloons.

EXAMPLE 32 Balloon Coating of Formulation 9 and Characterization

Formulation 9 was coated onto 3.0×20 mm Nylon 12 percutaneoustransluminal coronary angioplasty (PTCA) balloon catheters and 5.0×60 mmNylon 12 percutaneous transluminal angioplasty (PTA) balloon cathetersby a drop-and-drag coating method and dried overnight to form coatingscontaining varying sirolimus loading (3.0-7.0 μg/mm²). SEM images of allcoated balloons displayed the expected crystalline drug morphology (seeFIG. 15).

EXAMPLE 33 Balloon Process Conditions and Characterization

PTCA balloon catheters were coated with Formulation 9 as in Example 32and subjected to various drying processes immediately after coating:Process 1: room temperature overnight; Process 2: heat (50° C.) for 1 to5 days; Process 3: heat (50° C.) and vacuum for 1 to 5 days. All coatedballoons were then sterilized by EtO. SEM images of all coated balloonsdisplayed the expected crystalline drug morphology. Process 2 andProcess 3 balloon coatings showed fewer morphological changespost-sterilization suggesting bulk removal of solvent (FIG. 16).Residual MTBE solvent: Process 1 pre-sterilization 59120 ppm,post-sterilization 12810 ppm; Process 2 pre-sterilization 7910 ppm,post-sterilization 2011 ppm; Process 3 pre-sterilization 2104 ppm,post-sterilization 400 ppm.

EXAMPLE 34 Coupon Release in PBS Tween Buffer

Formulation 9, Formulation 10 (amorphous control), and a suspension ofCompound 1 with 80 mg/mL sirolimus (crystalline control, as described inExample 30) were drop-casted onto Nylon 12 coupons and dried as inExample 33. Nylon 12 coupons were immersed in 40 mL of PBS tween bufferand placed in a shaker at 37° C. for 24 hours. Buffer exchanges wereperformed at 1 hour and 2 hours to remove loose particles. At 24 hours,PBS tween was removed from the container, and the concentration ofsirolimus release in PBS tween buffer was directly quantified usingRP-HPLC (FIG. 17). The remaining sirolimus on coupon was measured bydissolving the coating in acetonitrile and quantified using RP-HPLC.Nylon 12 coupons of Formulation 9 dried with Process 2 and 3 had similarsirolimus release to the crystalline control, suggesting that thesecoatings were substantially crystalline and would have longer retentionin vivo compared to amorphous coatings (Formulation 10) due to lowersolubility.

EXAMPLE 35 Balloon Release

PTCA balloon catheters were coated and dried in a similar fashion asExample 34. After EtO sterilization, balloons were immersed in 40 mL ofPBS tween buffer and placed in a shaker at 37° C. for 24 hours. Bufferexchanges were performed at 1 hour and 2 hours to remove looseparticles. At 24 hours, PBS tween was removed from the container, andthe concentration of sirolimus release in PBS tween buffer was directlyquantified using RP-HPLC. The remaining sirolimus on PTCA ballooncatheters was measured by dissolving the coating in acetonitrile andquantified using RP-HPLC.

24 h Sirolimus release post sterilization (μg/mL): Formulation 9+Process 1, 0.42 μg/mL; Formulation 9+Process 2, 0.39 μg/mL; Formulation9+Process 3, 0.42 μg/mL; crystalline control, 0.37 μg/mL; and amorphouscontrol, 2.29 μg/mL. These results suggest that balloons coated withFormulation 9 were substantially crystalline and would have longerretention in vivo compared to amorphous coatings (Formulation 10) due tolower solubility.

EXAMPLE 36 Bioactivity of Released Sirolimus

Formulation 7 and Formulation 9, each at a sirolimus-to-Compound 1 ratioof 80:20 w/w, were drop-casted onto Nylon 12 coupons and sterilized byEtO. Corresponding sirolimus-only control samples were prepared at thesame concentrations and in the same solvent systems as Formulation 7 andFormulation 9 by drop-casting onto Nylon 12 coupons, and then sterilizedby EtO. Under sterile conditions, the Nylon 12 coupons were immersed inDulbecco's Modified Eagle Medium (DMEM) and placed in a shaker at 37° C.for 5 hours towards a target concentration >20 ng/mL of releasedsirolimus. Concentrations in DMEM were directly quantified usingRP-HPLC, then adjusted to 20 ng/mL by dilution with DMEM and FetalBovine Serum (FBS, 10% overall content). An additional control samplefor sirolimus at the same concentration (20 ng/mL) was prepared byspiking an acetone solution directly into cell culture media (DMEM with10% FBS). Sterile conditions were ensured by filtration of the acetonestock solution through a syringe filter of 0.2 μm pore size.

The bioactivity of released sirolimus in cell culture media wasevaluated using the WST-1 assay to assess cell growth inhibition. RatAortic Smooth Muscle Cells (RASMCs) were first seeded in two 96-wellplates and cultured overnight. The growth media was removed byaspiration and exchanged with the drug release samples described above,each adjusted to 20 ng/mL. Metabolic activity was then measured after agrowth period of 72 hours using an analytical wavelength of 450 nm, anda reference wavelength of 650 nm. Data were normalized against RASMCsgrown in drug-free media, and compared against cell culture media spikedwith sirolimus at 20 ng/mL, prepared as described above. Growthinhibition results were similar for all samples, which confirms thatsirolimus released from a sterilized coating in the presence or absenceof Compound 1 retains drug potency. These values were also equivalent tothose of freshly-spiked culture media at the same concentration.Normalized cell growth at 72 hours: drug released from Formulation 7coupon 0.338 ±0.016; drug released from sirolimus coupon prepared withFormulation 7 solvent system 0.329±0.035; drug released from Formulation9 coupon 0.341±0.016; drug released from sirolimus coupon prepared withFormulation 9 solvent system 0.291±0.031; drug spiked directly intogrowth media 0.463±0.035.

EXAMPLE 37 Particle Size Analysis for Formulation 9

A suitable apparatus was used based on the principle oflight-obscuration that allows for an automatic determination of the sizeof particles and the number of particles according to size. Anenvironmental check was performed as per USP <788> to confirmsuitability of the testing environment. The apparatus is calibratedusing dispersions of spherical particles for known sizes between 10 mmto 150 mm. These standard particles were dispersed in particle-freewater. Care was taken to avoid aggregation of particles duringdispersion. USP41-NF36 S1<788> was used as a guideline for sampletesting.

Particle Size Analysis on PTCA Balloon Catheters

Phosphate buffered saline at 37° C. was filled through silicone tubingconnections. A Nylon 12 PTCA balloon catheter coated with Formulation9+Process 1 was tracked through the silicone tubing, then inflated toestablish contact with silicone tubing. Once inflated, the balloon washeld in place for 1 minute, and then deflated and removed from thetubing. Buffer after inflation was analyzed by a HIAC Liquid ParticleCounter (MII B16712). Noted that uncoated PTCA balloon catheters wereused as control samples. The cumulative number of particles weremeasured for (i) Formulation 9 of 3 μg/mm² on 3×20 mm Nylon 12 PTCAballoon catheter (>10 μm: 7223; >25 μm: 777; >70 μm: 11) and (ii) forFormulation 9 of 6 μg/mm² on 3×20mm Nylon 12 PTCA balloon catheter (>10μm: 6027; >25 μm: 888; >70 μm: 10).

Particle Size Analysis Conclusions

The particle counts observed for Formulation 9 coated on Nylon 12 PTCAballoon catheters was significantly lower that the particle counts ofcoronary artery PTX competitors: 3.5×20mm Minvasys PTX coated ballooncatheter (>10 μm: 22730; >25 μm: 2326; >70 μm: 16, normalized to 3×20mmballoon size), and 2.75×20 mm Minvasys PTX coated balloon catheter (>10μm: 39989; >25 μm: 3712; >70 μm: 26, normalized to 3×20 mm balloonsize), and 3×20 mm Pantera Lux® paclitaxel-eluting balloon (>10 μm:108356; >25 μm: 13761; >70 μm: 63). Particle counts relative tocrystalline sirolimus in Formulation 9 was not significantly differentlyfrom particle counts relative to the crystalline PTX in Formulation 1.

EXAMPLE 38 Assessment of Therapeutic Retention of Formulation 9 BalloonCoating under Flow Conditions (Flow Loop Model)

Phosphate buffered saline at 37° C. was pumped through silicone tubingconnections. The pump flow rate was set similar to the rate of bloodflow through femoral arteries (350 mL/min). A Nylon 12 PTA ballooncatheter coated with Formulation 9+Process 2 was placed in the middle ofthe buffer flow for 2 minutes. The sirolimus remaining on the ballooncatheter was measured by dissolving the coating in acetonitrile andquantified using RP-HPLC. The % sirolimus remaining was observed to be89% for PTA containing 3.0 μg/mm² sirolimus and 82% for PTA containing6.0 μg/mm² sirolimus. Sirolimus retention for Formulation 9 was higherthan drug retention of PTX competitor benchmarks: Ranger, 99%, Lutonix,52%, Stellarex, 71%, and In.Pact, 62% (see FIG. 18). The high retentionof sirolimus observed for Formulation 9 was similar to the highretention of PTX observed for Formulation 1, 93% for Nylon 12 PTAballoon catheter coated with Formulation 1 and 85% for Pebax PTAlithotripsy catheter coated with Formulation 1 (see FIG. 18). This wouldsuggest that a high percentarge of the sirolimus payload would beavailable at the target site and not reduced by transit-associated loss.

EXAMPLE 39 Assessment of Post-Treatment Retention of Formulation 9Balloon Coating under Flow Conditions (Flow Loop Model)

Phosphate buffered saline at 37° C. was pumped through silicone tubingconnections. The pump flow rate was set similar to the rate of bloodflow through femoral arteries (350 mL/min). A Nylon 12 PTCA ballooncatheter coated with Formulation 9+Process 1 and Formulation 9+Process 2was tracked through the silicone tubing under flow, then inflated toestablish contact with silicone tubing. Once inflated, the balloon washeld in place for 1 minute, and then deflated and removed from thetubing. The siroliums remaining on the balloon catheter was measured bystripping the coating and quantified using RP-HPLC.

Less drug retention was observed after sterilization for Formulation9+Process 1 while drug residual on balloon was same pre and poststerilization for Formulation 9+Process 2. Process 2 improvedconsistency of performance post sterilization. Post treatment retentionof Formulation 9 was within the range of the retention of ConceptMedical Magic Touch® drug-eluting balloon: 39% and Nylon 12 PTCA coatedwith Formulation 1:58% (see FIG. 19).

EXAMPLE 40 PK Study in Coronary Artery Porcine Model

3.0 mm×20 mm Nylon 12 PTCA balloon catheter coated with Formulation9+Process 2 at 3.0 and 6.0 μg/mm² were sterilized with EtO and inflatedin porcine coronary arteries similar to Example 23 at a balloonoverstretch ratio of ˜20%. Concept Medical MagicTouch® DCB were used ascontrols.

Animals were sacrificed at a specified time point (29d) and targetvessels harvested. The proximal untreated tissue and the distaluntreated tissue were also harvested. The concentration of sirolimus wasmeasured in the vessels using a liquid chromatography-tandem massspectrometry (LC-MS/MS) assay; results are shown in Table 5.

TABLE 5 Sirolimus Sirolimus Levels Content in Artery Sample Drug Coating(μg/mm²) Overstretch (μg/g) Size Formulation 9 3.0 26 ± 5% 0.83 ± 0.57 4Formulation 9 6.0 15 ± 3% 7.98 ± 8.58 3 Magic Touch 1.3 15 ± 2% 0.26 ±0.33 2

EXAMPLE 41 Histopathology Study in Coronary Artery Porcine Model

3.0 mm×20 mm Nylon 12 balloon catheter coated with Formulation 9+Process2 at 3.0 and 6.0 μg/mm² are sterilized with EtO and inflated in porcinecoronary arteries similar to Example 40. Uncoated balloons (POBA) areused as controls and inflated in a similar fashion. At termination 28days after balloon inflation, the animals are euthanized, the mainorgans are excised and examined for any abnormalities, and the heart isperfused with lactated Ringer's solution, then neutral buffered formalinand processed for histology. Artery segments are embedded in paraffin,sectioned (approximately 5 μm) and stained with hematoxylin and eosin(H&E) and Movat stain. Analysis by the study pathologist includesemi-quantitative and descriptive histopathology and histomorphometry.

EXAMPLE 42 PK Study in Peripheral Artery Porcine Model

5.0 mm×60 mm Nylon 12 PTA balloon catheter coated with Formulation9+Process 2 at 3.0 and 6.0 μg/mm²were sterilized with EtO and inflatedin porcine peripheral arteries similar to Example 21 at a balloonoverstretch ratio of ˜12%. Animals were sacrificed at a specified timepoint (29d) and target vessels harvested. The treated vessel (60 mm) wascut into 3 treated segments (each segment: 20 mm length) that wereanalyzed separately. The proximal untreated tissue and the distaluntreated tissue were also harvested. The concentration of sirolimus wasmeasured in the vessels using a liquid chromatography-tandem massspectrometry (LC-MS/MS) assay; results shown in Table 6 were calculatedby taking the maximum value of the 3 treated segments.

TABLE 6 Sirolimus Sirolimus Levels Content in Artery Sample Drug Coating(μg/mm²) Overstretch (μg/g) Size Formulation 9 3.0 13 ± 5% 0.44 ± 0.18 6Formulation 9 6.0 11 ± 4% 1.17 ± 1.26 5

EXAMPLE 43 Assessment of Post-Treatment Retention of Balloon Coating ina Porcine Model

The remaining coating on the balloon catheter after the procedure inExamples 40-42 were extracted with appropriate solvent and sirolimusquantified by RP-HPLC. % sirolimus remaining on balloons: PTCA 3.0μg/mm² 12%, PTCA 6.0 μg/mm² 10%, PTA 3.0 μg/mm² 30%, PTA 6.0 μg/mm² 19%,Concept Medical MagicTouch PTCA 20%.

OTHER EMBODIMENTS

All publications, patents, and patent applications mentioned in thisspecification are herein incorporated by reference to the same extent asif each independent publication or patent application was specificallyand individually indicated to be incorporated by reference.

While the invention has been described in connection with specificembodiments thereof, it will be understood that it is capable of furthermodifications and this application is intended to cover any variations,uses, or adaptations of the invention following, in general, theprinciples of the invention and including such departures from thepresent disclosure that come within known or customary practice withinthe art to which the invention pertains and may be applied to theessential features hereinbefore set forth, and follows in the scope ofthe claims.

Other embodiments are within the claims.

1-34. (canceled)
 35. A coating comprising: (i) from 3% to 35% (w/w) of acompound of formula (I)F_(T)—[B—(oligo)]_(n)—B—F_(T)  (I), wherein B is a hard segment formedfrom hexamethylene diisocyanate, oligo is an oligomeric segmentincluding polytetramethylene oxide, F_(T) is a polyfluoroorgano group,and n is an integer from 1 to 10; and (ii) from 70% to 97% (w/w)crystalline rapamycin macrolide.
 36. The coating of claim 35, whereinthe coating comprises (i) from 5% to 25% (w/w) of the compound offormula (I) and (ii) from 75% to 95% (w/w) crystalline rapamycinmacrolide.
 37. The coating of claim 35, wherein the coating comprises(i) from 15% to 25% (w/w) of the compound of formula (I) and (ii) from75% to 85% (w/w) crystalline rapamycin macrolide.
 38. The coating ofclaim 35, wherein the polytetramethylene oxide has a molecular weight offrom about 800 Da to 3,000 Da. 39-44. (canceled)
 45. The coating ofclaim 35, wherein the coating has a thickness of from 0.01 to 250microns.
 46. The coating of claim 35, wherein the coating comprises acrystalline rapamycin macrolide concentration of from 1.0 μg/mm² to 10.0μg/mm².
 47. The coating of claim 46, wherein the crystalline rapamycinmacrolide concentration is from 1.0 μg/mm² to 6.0 μg/mm². 48-56.(canceled)
 57. A balloon catheter, wherein at least a portion of thesurface of the balloon catheter comprises a coating of claim
 35. 58-61.(canceled)
 62. A method of delivering a rapamycin macrolide to a vesselsurface of a mammal, the method comprising contacting the vessel surfacewith a coating of claim
 35. 63-75. (canceled)
 76. The method of claim62, wherein the rapamycin macrolide is selected from sirolimus,zotarolimus, everolimus, temsirolimus, ridaforolimus, umirolimus, andbiolimus.
 77. The method of claim 76, wherein the rapamycin macrolide issirolimus.